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Intern Supervisor: VS
Diagnosis
One positive result of culture of blood samples obtained from the peripheral vein Clinical manifestations of infection. No apparent source for bloodstream infection One of the following should be present
a positive result of semiquantitative (15 cfu per catheter segment) or quantitative (102 cfu per catheter segment) catheter culture same organism (species and antibiogram) simultaneous quantitative cultures of blood samples with a ratio of 5:1 (CVC vs. peripheral); CVC sample differential time to positivity 2 h earlier than peripheral blood)
Management
Remove the central venous catheter / implantable device or not?
Depending on the complications and specific microorgainsm.
Salvage therapy for infected tunneled CVCs or IDs is not recommended for routine use
Salvage rates with systemic fungal therapy and antibiotic lock therapy for Candida species have been about 30%.
Summery
Paired quantitative blood culture is recommended especially in tunneled CVD/ID to confirm diagnosis. TEE should be done to rule out vegetations in S. aureus bloodstream infection. For complicated infections, the CVC/ID should be removed. For uncomplicated intraluminal bacterial infection in the absence of tunnel or pocket infection, 2 weeks systemic therapy with antibiotic lock therapy add chance to salvage the CVC/ ID.